Comparison of a Pulsed Dye Laser and a Combined 585/1,064-nm Laser in the Treatment of Acne Vulgaris

A 595 nm pulsed dye laser as an adjuvant intervention for post-comedone extraction erythema and comedone reduction: A randomized, split-face controlled trial

BACKGROUND

Comedone extraction provides greater satisfaction for acne treatment than conventional treatment alone; however, post-comedone extraction erythema (PCEE) remains a concern for patients.

OBJECTIVES

To evaluate the efficacy of pulsed-dye laser (PDL) in PCEE and comedone reduction.

METHODS

Mild-to-moderate acne patients were randomly allocated in split-face fashion. Three comedones were extracted on each facial side. On the PDL-treated side, 595-nm PDL was delivered to the entire side with an additional shot on three comedone-extracted sites. Erythema index (EI) and total acne lesion counts (TALC) were evaluated at baseline, week 2 and 4. The comprehensive acne severity scale (CASS) was assessed by three blinded independent pediatric dermatologists. Participant satisfaction surveys were completed at the end of the study.

RESULTS

Thirty-five participants (age 12.9-24.2 years) showed no differences in the EI and TALC at baseline on both sides. At weeks 2 and 4, the EI on the PDL-treated side was significantly lower (p < 0.001) with a greater EI reduction (p < 0.001) when compared to the control side regardless of gender and menstruation. There was significantly lower TALC on the PDL-treated side at week 2 (p < 0.001) and week 4 (p = 0.02). No complications were noted with high participant satisfaction reported (median 8; IQR 7-9). PDL remained significantly associated with EI improvements after controlling for gender, menstruation cycle, and examination stress.

CONCLUSION

PDL can be an adjunctive intervention for the treatment of PCEE and comedone reduction due to its effectiveness and high participant satisfaction.

Efficacy and Safety of Solid-state Dual-wavelength Lasers for the Treatment of Moderate-to-severe Inflammatory Acne in Asian Populations

Background

Standard treatments for moderate-to-severe acne often require oral medications but are not long-lasting or free from side effects. We aimed to evaluate the efficacy and safety of a solid-state dual-wavelength laser for moderate-to-severe inflammatory acne in an Asian population.

Methods

Forty individuals with moderate-to-severe acne received nightly topical retinoids and two to three weekly treatments with a 1319-nm laser followed by a 589-nm laser (five sessions in total). Patients were evaluated at pretreatment baseline, at monthly intervals, and at 1 month after the last laser for pain, seborrhea, global aesthetic improvements, and satisfaction, using standardized digital photography and global assessment scales. Fifteen patients had an additional evaluation 3 months after the fifth session.

Results

At 1 month, all patients (n = 40) had improved inflammatory acne counts, with 72.5% having greater than 75% reduction in acne count, 7.5% having 51%-75% reduction, 17.5% having 26%-50% reduction and 2.5% having less than 25% reduction. Moreover, GAS evaluations showed that 62.5% of patients improved to almost clear and 37.5% to mild acne (P = 0.0478), while improvements were sustained in patients with 3-month follow-ups. Erythema (n = 29) improved with 65.5% of affected patients having greater than 75% reduction. Patients (n = 17) with pigmentation experienced lightening, with 52.9% of affected patients having a greater than 75% reduction. With low pain scores (mean 3.68 of 10, median 4 of 10), the treatment was well-tolerated. All patients (n = 40) reported acne improvements with 95% having much improved or very much improved, and 95% either satisfied or very satisfied.

Conclusions

Dual-wavelength lasers effectively and safely treat moderate-to-severe inflammatory acne with high patient satisfaction. It is ideal for patients who refuse or are contraindicated to oral medications, and patients with acne-associated pigmentation, erythema and seborrhea.

The Efficacy of Pulsed Dye Laser Treatment for Acne Vulgaris: A Systemic Review and Meta-Analysis

BACKGROUND

Previous reports have shown that pulsed dye laser (PDL) is promising for the treatment of acne; however, results provide conflicting evidence.

OBJECTIVE

To determine the efficacy of PDL in treating acne vulgaris.

METHODS

A systematic review and meta-analysis of studies published before March 31, 2020 was conducted. Randomized controlled trials and case series were analyzed. The meta-analysis estimated the standardized mean difference (SMD) in acne severity score changes in patients treated by PDL versus control and also the SMD of the acne severity scores and comedone counts changes before and after PDL treatment.

RESULTS

Eleven studies were included in this systematic review. Six studies were included in the meta-analysis. Pulsed dye laser treatment was not found to be superior to the control group in treating acne vulgaris (SMD: -0.285; 95% confidence interval [CI], -0.886 to 0.317). However, single-arm studies revealed a significantly improved acne severity score after PDL therapy (SMD, -1.321; 95% CI, -2.057 to -0.586), especially when a multiple-session treatment and a longer pulse duration were employed. The comedone counts were significantly decreased after PDL therapy (SMD, -0.596; 95% CI, -1.137 to -0.054).

CONCLUSION

When treatment consisted of 4 or more sessions or longer pulse duration, PDL could significantly decrease the acne severity score.

Clinical evaluation of efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Neodymium:YAG laser in the treatment of inflammatory acne vulgaris in adolescent and post-adolescent patients: a prospective randomized split-face comparative study

Large numbers of local and systemic therapies are available for acne treatment. Common oral or topical retinoids, antibiotics, or keratolytics are used but sometimes are inconvenient, and side effects caused by these conventional therapies prompted a search for effective and safe treatments. This study aimed to evaluate the efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Nd:YAG laser in the treatment of moderate inflammatory acne vulgaris in both adolescents and post-adolescent patients. This split-face comparative study was carried out on thirty patients who suffered from moderate inflammatory and non-inflammatory acne vulgaris. The patients were classified into two groups: group I: adolescent (≤ 25 years) and group II: post-adolescent (< 25 years). Each group received four sessions of intralesional PRP injection on one side of the face and a long-pulsed Nd:YAG (1064 nm) laser on the other side with 2 weeks interval. Evaluation was done by blinded dermatologists using photographs and lesions counting and by patient satisfaction. Side effects were also noted. Both groups (adolescents and post-adolescent) showed a high statistically significant improvement of inflammatory as well as non-inflammatory lesions either in PRP or Nd:YAG laser–treated side with no significant difference between the two sides. The intralesional PRP injection and 1064 nm long-pulsed Nd:YAG laser are safe and effective methods for controlling inflammatory as well as non-inflammatory acne vulgaris in both adolescents and post-adolescent patients.

The comparative study of efficacy between 1064-nm long-pulsed Nd:YAG laser and 595-nm pulsed dye laser for the treatment of acne vulgaris

BACKGROUND

The popularity of laser therapy in acne treatment has been increasing recently due to its safety, effectiveness, and convenience. Both 595-nm pulsed dye laser (PDL) and 1064-nm long-pulsed neodymium:yttrium-aluminum-garnet laser (Nd:YAG) have been successful in treating inflammatory acne lesions. However, clinical data from controlled comparative studies are still lacking.

AIMS

To compare the clinical efficacy of 1064-nm Nd:YAG with 595-nm PDL for the treatment of acne vulgaris.

METHODS

Thirty-four participants with mild to moderate facial acne were enrolled and then randomized to receive three, 2-week interval treatments with 1064-nm Nd:YAG on one side of the face and 595-nm PDL on the other side. Clinical assessments including acne lesion counts, acne erythema grading, and erythema index were performed at baseline, 2nd, 4th, and 8th week. Participants' satisfaction, preference, and adverse effects were recorded.

RESULTS

As compared with baseline, the significant reduction of mean inflammatory acne lesion counts, acne erythema grading, and erythema index was demonstrated on 595-nm PDL-treated sides and 1064-nm Nd:YAG-treated sides. However, there were no significant differences between both sides. The participants were satisfied with both laser treatments, but the participants preferred 1064-nm Nd:YAG over 595-nm PDL treatment. The adverse effects were less on 1064 nm Nd: YAG-treated sides.

CONCLUSIONS

1064-nm Nd:YAG and 595-nm PDL treatments are equally effective in reducing inflammatory acne lesions and acne erythema in mild to moderate facial acne vulgaris.

Combined Low-Dose Isotretinoin and Pulsed Dye Laser Versus standard-Dose Isotretinoin in the Treatment of Inflammatory Acne

BACKGROUND AND OBJECTIVES

Acne is a widespread disorder of the pilosebaceous unit. Isotretinoin is the background treatment of cases of severe acne. Side effects associated with the standard 0.5-1 mg/kg/day dose decrease patient compliance. Pulsed dye laser (PDL) was proved effective in the management of inflammatory acne. The focus was to evaluate the efficacy of combining low-dose isotretinoin (0.25 mg/kg/day) with PDL in comparison with the standard higher-dose isotretinoin (0.5 mg/kg/day) as monotherapy for the management of acne vulgaris.

STUDY DESIGN/MATERIALS AND METHODS

The current prospective randomized comparative study included 46 acne patients, who were randomly divided into two groups. The first (ISO/PDL group) was treated with oral isotretinoin (0.25 mg/kg/day) and five sessions of PDL. The second (ISO group) was treated with oral isotretinoin (0.5 mg/kg/day). The physician's clinical assessment was done by three blinded dermatologists using quartile scale score and erythema score at baseline, 3 months, and 6 months and global acne grading system (GAGS) at baseline and 6 months. Patient satisfaction was assessed using the Cardiff Acne Disability Index (CADI).

RESULTS

Both groups showed a significant improvement in all assessed parameters compared with baseline at 3 and 6 months. Comparing both groups together, the ISO/PDL group showed a statistically significantly greater improvement regarding all parameters at both assessment times. Regarding adverse events, six patients (26%) suffered from flare in the ISO group versus none in the combined group. Dryness was encountered in 20 patients (86%) in the ISO group versus five patients (21%) in the other group. The ISO/PDL group received significantly less cumulative isotretinoin dosage (48.7 ± 5.7 mg/kg) in comparison to the ISO group (100.4 ± 3.1 mg/kg) (P < 0.05).

CONCLUSION

The current study offers a new collaboration between two well-studied and established treatment modalities leading to a harmony of therapeutic synergism while minimizing the risk of side effects. Longer periods of follow-up are recommended to diagnose any relapses and modify the proposed protocol. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Nd:YAG laser vs IPL in inflammatory and noninflammatory acne lesion treatment

BACKGROUND

Several topical and systemic therapies are available for the treatment of acne vulgaris but are associated with several limitations, and recently, intense pulse light (IPL) and long-pulsed 1064 nm Nd: YAG laser have shown efficacy.

AIMS

The current study aimed to compare the efficacy of Nd:YAG laser and IPL in inflammatory and noninflammatory acne lesions.

PATIENTS AND METHODS

Thirty patients with inflammatory and noninflammatory facial acne were assigned randomly and equally into two groups, the Nd:YAG and IPL groups. The patients received three sessions of laser 2 weeks apart, and the clinical improvement was assessed by the reduction in the number of lesions.

RESULTS

At baseline, the two groups showed a nonsignificant difference as regards total number (P = .476), inflammatory (P = .457), and noninflammatory lesions (P = .420). The improvement in total lesions was significant in the Nd:YAG Group but nonsignificant in the IPL Group (P < .001, P = .13, respectively). Three patients (20%) in the IPL Group showed exacerbation after the first and second sessions. One month after the last session, the difference in improvement between noninflammatory and inflammatory lesions showed a significant difference in the Nd:YAG Group (P = .017) and a nonsignificant difference in the IPL Group (P = .823). Nd:YAG, compared to the IPL Group, showed a significant difference as regards the improvement score in noninflammatory lesions (P = .0099) and a nonsignificant difference in inflammatory lesions (P = .4295).

CONCLUSION

The significant improvement in noninflammatory lesions and the absence of a significant flare-up of acne as seen among patients treated with IPL make Nd:YAG a better therapeutic modality for acne.

Nonvascular uses of pulsed dye laser in clinical dermatology

Lasers are fast becoming the vogue of dermatology ranging from ablative, nonablative, fractional photothermolysis to vascular lasers. There are a range of vascular lasers including potassium titanyl phosphate (KTP 532 nm), pulsed dye laser (PDL -595 nm), diode (810 nm), and Nd:YAG (1064 nm). PDL is a laser that emits yellow light using Rhodamine dye as it is lasing medium. Typical vascular lesions which are treated by PDL include port wine stain, hemangioma, telangiectasia, spider angioma, and rosacea. This article focuses on the use of PDL beyond primary vascular conditions. We review the evidence, or lack thereof, of the use of PDL in acne vulgaris, scars, striae, warts, molluscum, psoriasis, rejuvenation, basal cell carcinoma (BCC), and miscellaneous dermatological sequelae.

[Light-based inflammatory acne treatments]

Light-based acne treatments may represent a new emerging treatment for acne that does not increase the risk of bacterial resistance and they may be potentially effective with a favorable safety profile. Current data show that photodynamic therapy reduces inflammatory lesions and significantly improves acne. However, there is no consensus on the optimal implementation in the treatment of acne. In addition to topically applied photodynamic therapy, intense pulsed light, pulsed dye lasers, potassium-titanyl-phosphate lasers, infrared diode lasers, broad-spectrum continuous-wave light sources (red light, blue-red light) have been introduced as alternative treatments. Since well-designed studies to evaluate their efficacy versus traditional medical therapies are lacking and standardized regimens have not been agreed upon, procedures including laser, intense pulsed light, and photodynamic therapy should currently not be considered first-line treatment for inflammatory acne.

Sustained Benefit After Treatment of Acne Vulgaris Using Only a Novel Combination of Long-Pulsed and Q-Switched 1064-nm Nd: YAG Lasers

BACKGROUND

Acne vulgaris remains a challenging disease to treat in many patients. Traditional therapies may have limited successes with potential side effects. Laser and light energy devices may offer a desirable alternative.

OBJECTIVE

To evaluate the effectiveness and safety in using a combination laser approach with both long-pulsed (LP) and Q-switched (QS) Nd:YAG lasers in the treatment of active acne.

METHODS

Twenty patients with moderate to severe inflammatory acne were treated with LP YAG laser followed immediately with QS YAG laser. Patients received at least 8 treatments. Follow-up evaluation occurred at a minimum of 12 months. Pre- and post-treatment photographs were graded by blinded physicians. All topical acne medications and oral antibiotics were discontinued throughout the therapy and follow-up period.

RESULTS

There was a 81% reduction in acne lesions, with 60% of patients having 90% or greater reduction. Overall appearance was graded at 84% improvement at follow-up. Follow-up occurred at a mean of 22.7 months after completion of therapy. Aside from transient erythema, there were no other adverse effects.

CONCLUSION

Active acne can be treated successfully with a combination of LP and QS YAG lasers with patients remaining off acne medications throughout laser therapy and the follow-up period.

Visually augmented targeted combination light therapy for acne vulgaris: a case report

BACKGROUND

Acne vulgaris is a common skin disease. Pharmacological modalities for treatment are proven to be efficacious but have limitations. Light therapy for acne vulgaris has shown promise in previous studies. This case report and its accompanying images show how a novel approach of visually augmented high fluence light therapy has been used to good effect.

CASE PRESENTATION

A 26-year-old Caucasian woman with acne vulgaris resistant to treatment with topical therapy underwent three sessions of combination potassium titanyl phosphate laser (532 nm)/neodymium-doped: yttrium aluminum garnet laser (1064 nm) light therapy with visually augmented narrow spot size and high fluence. A 73% reduction in total inflammatory lesions was evident 6 months after the initial treatment.

CONCLUSIONS

This case report illustrates that there may be utility in this novel approach of narrow spot size, magnification-assisted, high fluence targeted combination laser therapy for inflammatory acne.

Laser treatments of active acne

The utility of laser therapy is increasingly being recognized in the treatment of active acne vulgaris. We aimed to perform a narrative review of the medical literature on the use of laser therapy for the treatment of active acne vulgaris. We performed a PubMed literature search on September 1, 2016 using the search terms "active acne," "acne," "laser therapy," and "laser surgery." Case reports, case series, cohort, and controlled trials were included. Studies of lasers in the treatment of acne, including erbium glass, Nd:YAG, pulse dye laser (PDL), potassium titanyl phosphate (KTP) laser, and laser-based photodynamic therapy, have been published. While treatment of active acne with lasers has been successful, many studies are limited by small patient number and lack of control populations and comparison to standard therapies for active acne. Laser therapies are increasingly becoming part of or an adjunct to the medical treatment of active acne and are a useful treatment modality.

Light therapies for acne

BACKGROUND

Acne vulgaris is a very common skin problem that presents with blackheads, whiteheads, and inflamed spots. It frequently results in physical scarring and may cause psychological distress. The use of oral and topical treatments can be limited in some people due to ineffectiveness, inconvenience, poor tolerability or side-effects. Some studies have suggested promising results for light therapies.

OBJECTIVES

To explore the effects of light treatment of different wavelengths for acne.

SEARCH METHODS

We searched the following databases up to September 2015: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and LILACS. We searched ISI Web of Science and Dissertation Abstracts International (from inception). We also searched five trials registers, and grey literature sources. We checked the reference lists of studies and reviews and consulted study authors and other experts in the field to identify further references to relevant randomised controlled trials (RCTs). We updated these searches in July 2016 but these results have not yet been incorporated into the review.

SELECTION CRITERIA

We included RCTs of light for treatment of acne vulgaris, regardless of language or publication status.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 71 studies, randomising a total of 4211 participants.Most studies were small (median 31 participants) and included participants with mild to moderate acne of both sexes and with a mean age of 20 to 30 years. Light interventions differed greatly in wavelength, dose, active substances used in photodynamic therapy (PDT), and comparator interventions (most commonly no treatment, placebo, another light intervention, or various topical treatments). Numbers of light sessions varied from one to 112 (most commonly two to four). Frequency of application varied from twice daily to once monthly.Selection and performance bias were unclear in the majority of studies. Detection bias was unclear for participant-assessed outcomes and low for investigator-assessed outcomes in the majority of studies. Attrition and reporting bias were low in over half of the studies and unclear or high in the rest. Two thirds of studies were industry-sponsored; study authors either reported conflict of interest, or such information was not declared, so we judged the risk of bias as unclear.Comparisons of most interventions for our first primary outcome 'Participant's global assessment of improvement' were not possible due to the variation in the interventions and the way the studies' outcomes were measured. We did not combine the effect estimates but rated the quality of the evidence as very low for the comparison of light therapies, including PDT to placebo, no treatment, topical treatment or other comparators for this outcome. One study which included 266 participants with moderate to severe acne showed little or no difference in effectiveness for this outcome between 20% aminolevulinic acid (ALA)-PDT (activated by blue light) versus vehicle plus blue light (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.04, low-quality evidence). A study (n = 180) of a comparison of ALA-PDT (activated by red light) concentrations showed 20% ALA was no more effective than 15% (RR 1.05, 95% CI 0.96 to 1.15) but better than 10% ALA (RR 1.22, 95% CI 1.05 to 1.42) and 5% ALA (RR 1.47, 95% CI 1.19 to 1.81). The number needed to treat for an additional beneficial outcome (NNTB) was 6 (95% CI 3 to 19) and 4 (95% CI 2 to 6) for the comparison of 20% ALA with 10% and 5% ALA, respectively.For our second primary outcome 'Investigator-assessed changes in lesion counts', we combined three RCTs, with 360 participants with moderate to severe acne and found methyl aminolevulinate (MAL) PDT (activated by red light) was no different to placebo cream plus red light with regard to change in inflamed lesions (ILs) (mean difference (MD) -2.85, 95% CI -7.51 to 1.81), percentage change in ILs (MD -10.09, 95% CI -20.25 to 0.06), change in non-inflamed lesions (NILs) (MD -2.01, 95% CI -7.07 to 3.05), or in percentage change in NILs (MD -8.09, 95% CI -21.51 to 5.32). We assessed the evidence as moderate quality for these outcomes meaning that there is little or no clinical difference between these two interventions for lesion counts.Studies comparing the effects of other interventions were inconsistent or had small samples and high risk of bias. We performed only narrative synthesis for the results of the remaining trials, due to great variation in many aspects of the studies, poor reporting, and failure to obtain necessary data. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold microparticle suspension to vehicle, and clindamycin/benzoyl peroxide combined with pulsed dye laser to clindamycin/benzoyl peroxide alone. There were also several other studies comparing MAL-PDT to light-only treatment, to adapalene and in combination with long-pulsed dye laser to long-pulsed dye laser alone. None of these showed any clinically significant effects.Our third primary outcome was 'Investigator-assessed severe adverse effects'. Most studies reported adverse effects, but not adequately with scarring reported as absent, and blistering reported only in studies on intense pulsed light, infrared light and photodynamic therapies. We rated the quality of the evidence as very low, meaning we were uncertain of the adverse effects of the light therapies.Although our primary endpoint was long-term outcomes, less than half of the studies performed assessments later than eight weeks after final treatment. Only a few studies assessed outcomes at more than three months after final treatment, and longer-term assessments are mostly not covered in this review.

AUTHORS' CONCLUSIONS

High-quality evidence on the use of light therapies for people with acne is lacking. There is low certainty of the usefulness of MAL-PDT (red light) or ALA-PDT (blue light) as standard therapies for people with moderate to severe acne.Carefully planned studies, using standardised outcome measures, comparing the effectiveness of common acne treatments with light therapies would be welcomed, together with adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

Treatment of Acne Vulgaris With Salicylic Acid Chemical Peel and Pulsed Dye Laser: A Split Face, Rater-Blinded, Randomized Controlled Trial

INTRODUCTION

Pulsed dye laser (PDL) has been used to treat acne lesions and scar erythema by interrupting superficial vasculature. Salicylic acid chemical peels are employed chiefly due to their lipophilic, comedolytic, and anti-inflammatory properties. Although studies have looked at peels and laser therapy independently in acne management, we examined these treatments in combination. Our primary objective was to evaluate the safety and efficacy of concurrent use of salicylic acid peels with PDL versus salicylic acid peels alone in the treatment of moderate to severe acne vulgaris.

METHODS

Adult patients with moderate to severe acne were included. Subjects received a total of 3 treatments at 3-week intervals. Per randomized split-face treatment, at week 0, one half of the subject's face was treated with PDL (595 nm) followed by whole face application of a 30% salicylic acid peel. At weeks 3 and 6, the treatments were repeated. At 0 and 9 weeks, patients were assessed with the Global Evaluation Acne (GEA) scale and Dermatology Life Quality Index (DLQI) questionnaire.

RESULTS

Nineteen subjects were enrolled, and 18 completed the study. Significant improvement in acne was seen in both the combined (laser and peel) and chemical peel alone treatment arms (P < .0005 and P = .001). Using the GEA scale score, compared to week 0, the mean difference in acne improvement at week 9 was -1.61 in the combination therapy group versus -1.11 in the peel only group. Based on the GEA scale scoring, a statistically significant greater difference in acne improvement was seen, from week 0 to week 9, in the combination treatment group compared with the peel only group (P = .003).

CONCLUSION

While acne subjects had significant benefit from the salicylic acid peel alone, they experienced greater significant benefit from PDL treatment used in conjunction with salicylic acid peels. The adjunctive utilization of PDL to salicylic acid peel therapy can lead to better outcomes in acne management.

Effects of the combined PDL/Nd:YAG laser on surgical scars: vascularity and collagen changes evaluated by in vivo confocal microscopy

The aim of this study was to investigate the efficacy of the sequential combined 585 nm PDL and the 1064 nm neodymium:yttrium-aluminium-garnet laser (PDL/Nd:YAG) in the treatment of surgical scars and to evaluate the short-term effects by in vivo confocal microscopy (RCM) and the long-term effects by clinical assessment of the scars. Twenty-five patients were enrolled with 39 postoperative linear scars; each scar was divided into two fields. One half was treated with the combined PDL/Nd:YAG laser, whereas the other half remained untreated. Each scar was treated three times at monthly intervals. Scars were evaluated by an independent examiner, using the Vancouver Scar Scale. The combined PDL/Nd:YAG laser significantly improved the appearance of the scars. In order to study the short-term effects of combined laser treatment, six additional patients were enrolled with 7 postoperative linear scars. One half of scars was treated once with the combined PDL/Nd:YAG laser. One week after this laser treatment, both the treated and the nontreated parts of the scars were examined by dermoscopy and RCM. The dermoscopic pictures revealed improvements even in treated areas. In conclusion, the combined PDL/Nd:YAG laser was found to be effective in improving the quality and appearance of the surgical scars.

Intense pulsed light enhances transforming growth factor beta1/Smad3 signaling in acne-prone skin

BACKGROUND

Recently, much interest has been generated in the use of intense pulsed light (IPL) sources in the treatment of various skin conditions. However, the underlying mechanism for its therapeutic action has not been elucidated.

OBJECTIVE

To investigate the effect of IPL on the in vivo expression of transforming growth factor beta1 (TGF-β1) and on the immunolocalization of Smad3 in biopsies obtained from perilesional skin in patients with mild-to-moderate inflammatory acne vulgaris.

METHODS

Biopsies obtained from 20 patients with inflammatory acne vulgaris at baseline (B1) and post-IPL treatment (B2 = 48 h after first treatment and B3 = 1 week after final treatment) were immunohistochemically analyzed to determine the expression of TGF-β1 and the immunolocalization of Smad3. Digital images were semiquantitatively assessed using image analysis software.

RESULTS

Intense pulsed light elicited a consistent increase in epidermal TGF-β1 expression (B2 vs. B1: P = 0.004 and B3 vs. B1: P = 0.007). Furthermore, it resulted in enhanced nuclear immunolocalization of Smad3 (B2 vs. B1: epidermis, P = 0.000055 and dermis, P = 0.014; B3 vs. B1: epidermis, P = 0.00024 and dermis, P = 0.008).

CONCLUSION

Intense pulsed light upregulates TGF-β1/Smad3 signaling in perilesional skin obtained from patients with mild-to-moderate inflammatory acne vulgaris. Further experiments on lesional skin and downstream effects are warranted to determine whether it may play a role in IPL-induced resolution of acne vulgaris.

1064 Nd:YAG laser for the treatment of chronic paronychia: a pilot study

Paronychia, which can be acute or chronic, is characterized by erythema, edema, and tenderness at the proximal and occasionally lateral nail folds. Causes of chronic paronychia include excessive moisture, contact irritants, trauma, and candida infection. Chronic paronychia is usually multifactorial and difficult to treat. The aim of the present work was to assess the role of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser as a new modality for the treatment of chronic paronychia. In this interventional pilot study, eight female patients suffering from long-standing paronychia received 2-5 Nd:YAG laser sessions (4 weeks apart). Fluences ranged between 70 to 80 J/cm(2), using a 2.5-mm spot size handpiece, and pulse duration was set at 0.7 ms. Patients were digitally photographed and clinically evaluated before starting the treatment and at each session. Seven of our patients showed various degree of improvement regarding erythema and swelling of their proximal nail folds. Nail plate abnormalities also improved in six patients. These preliminary results document the efficacy and feasibility of Nd:YAG laser as one of the treatments that could ameliorate chronic paronychia.

Investigator-blind, placebo-controlled, randomized comparative study on combined vacuum and intense pulsed light versus intense pulsed light devices in both comedonal and papulopustular acne

INTRODUCTION

The aim was to compare the treatment effectiveness of intense pulsed light (IPL) and vacuum versus IPL with placebo for mild to moderate comedonal and inflammatory acne.

PATIENTS AND METHODS

We randomized 180 patients with mild to moderate comedonal and inflammatory acne into three groups: Group A - 60 patients treated with vacuum and IPL, Group V - 60 patients treated with IPL, and Group 0 (control group) - 60 patients who received topical treatment with Sebium H2O Micellaire Solution. We evaluated the results using the Leeds revised acne-grading system and Cardiff Acne Disability Index.

RESULTS

There was a significant reduction in the number of papules, pustules, and comedones in Groups A and V compared with those in the control group (p < 0.001) with a more rapid decrease of the papules from Group A compared with that from Group V. We found an improvement in the clinical aspect (p < 0.001) when we compared Groups A and V with controls. Patients belonging to Group A were more satisfied compared with those belonging to Group V (p = 0.004) and significantly more satisfied compared with those belonging to Group 0 (p < 0.001). In conclusion, we consider that both the devices are efficient, the combination of vacuum and IPL representing a therapeutic option for the comedonal acne.

Prospective randomized controlled clinical and histopathological study of acne vulgaris treated with dual mode of quasi-long pulse and Q-switched 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension

BACKGROUND

Acne treatments using laser and light devices have been reported to have varying degrees of efficacy. However, there has been no study of treatment of acne using a dual mode (quasi-long pulse and Q-switched mode) 1064-nm Nd:YAG laser assisted with a topically applied carbon suspension.

OBJECTIVE

To evaluate the clinical efficacy, safety, and histological changes of new laser treatment method for acne vulgaris.

METHODS

Twenty-two patients received 3 sessions of quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension at 2-week intervals in a randomized split face manner.

RESULTS

At the final visit, the inflammatory acne lesions were reduced on the laser-treated side by 58.6% (P < .001), but increased on the untreated side by 5%. The noninflammatory acne lesions were reduced on the laser-treated side by 52.4% (P < .001). Sebum output reduction, inflammatory cell and cytokine reductions, a decrease of the thickness of a perifollicular stratum corneum and a full epithelium, and skin rejuvenation effect were found. The histopathologic examination of the acne lesions showed decreased inflammation and immunostaining intensity for interleukin 8, matrix metalloproteinase-9, toll-like receptor-2, and nuclear factor kappa B, and tumor necrosis factor alpha was reduced significantly. No severe adverse reactions were reported. All patients reported mild transient erythema that disappeared in a few hours.

LIMITATIONS

The number of subjects studied was small.

CONCLUSIONS

This laser treatment was rapid and effective for treating not only the inflammatory but also the noninflammatory acne lesions when compared with the control side. The histopathologic findings correlated well with the clinical acne grade and treatment response. This novel laser treatment appears to be safe and effective for acne treatment.

New approaches in light/laser therapies and photodynamic treatment of acne

Acne is a domain in which the technology and understanding of light/laser therapeutic procedures have advanced considerably. The aim of the paper was to revisit adjunctive physical treatments of acne, including light/laser treatments and photodynamic therapy. This review summarizes findings about such treatment modalities with particular emphasis on efficacy and safety. A number of laser/light-based modalities have been developed to meet the increasing demand for new acne treatments. The current devices correspond, on the one hand, to light-emitting diode therapy and, on the other hand, to the 532-nm potassium titanyl phosphate laser, the 585- and 595-nm pulsed dye laser, the 1450-nm diode laser, the 1320-nm Nd:YAG laser and intense pulsed light. Photodynamic therapy is also available. It is claimed that light/laser treatments might induce a faster response compared with the 1-3 months needed for response to traditional oral and topical treatments. In conclusion, pulsed dye laser shows efficacy in some patients with mild to moderate acne. The relative effectiveness compared with other treatments is unconfirmed; from the published information, evidence-based efficacy assessment of light/laser therapies in acne remains almost impossible.

The pulsed-dye laser as an adjuvant treatment modality in acne vulgaris: a randomized controlled single-blinded trial

BACKGROUND

Acne vulgaris is the most common skin disease and can pose a substantial therapeutic challenge. Recently, several phototherapeutic modalities, most notably pulsed-dye laser (PDL) treatment, have been introduced, but the published results - albeit promising - are controversial.

OBJECTIVES

To assess the efficacy of an adjuvant PDL treatment when combined with a proven topical treatment [fixed-combination clindamycin 1%-benzoyl peroxide 5% hydrating gel (C/BPO)].

METHODS

Eighty patients (38 males and 42 females, mean +/- SD age 19.7 +/- 5.9 years) were randomized in a 1 : 2 ratio to receive C/BPO alone or in combination with PDL treatment (wavelength 585 nm, energy fluence 3 J cm(-2), pulse duration 0.35 ms, spot size 7 mm). Patients were evaluated at baseline and at 2 and 4 weeks after initial treatment. The primary end points were the Investigator's Static Global Assessment (ISGA) score and lesion count; the secondary end point was the Dermatology Life Quality Index (DLQI).

RESULTS

Both groups showed a significant improvement during observation [ISGA 27.1% (C/BPO) and 24.6% (C/BPO + laser), total lesion count 9.2% and 9.0%, inflammatory lesion count 36.3% and 36.9%, DLQI 54.5% and 42.5%], but there was no significant or otherwise appreciable difference between treatment modalities as far as the extent of improvement was concerned. Patients with more severe findings at baseline had a greater benefit from either therapy regimen.

CONCLUSIONS

Our findings do not support the concept of a substantial benefit of PDL treatment in acne vulgaris.